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All Programming Kids Bar - Bat Mitzvah

Bar / Bat Mitzvah - registration form

Child's Profile
This is for a *

Bar MitzvahBat Mitzvah
Child's Full Name*
First Name Last Name
Hebrew Name
Tribe*

KohenLeviYisrael
Date of Birth*

Day Month Year
at Hour Minutes
Date Bar/Bat Mitzvah requested

Day Month Year
Use our Bar/Bat MItzvah Calculator to check the date
Type of Service*
Type of Ceremony*
In addition to Shabbat service would you like a weekday Service for Tefillin and a Call up to the Torah?

YesNo
Date of weekday service

Day Month Year
Hebrew Reading Proficiency

NoneBeginnerFluent
Jewish Knowledge Level

NoneBeginnerFluent
Do you have a Bar/Bat Mitzvah Teacher?

YesNo
Name of Teacher
Parents Information

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail*
Phone Number*
Father's Full Name
First Name Last Name
Father's Hebrew Name
Mother's Full Name
First Name Last Name
Mother's Hebrew Name
Confirmation*

I confirm that the mother of the above-named child is Jewish as defined by The London Beth Din and the Office of the Chief Rabbi. I have attached a copy of our Ketubah or that of the child's maternal Grandparents
Ketuba upload*
Suggested Donation* No one will be turned away due to lack of finances - please contact us to discuss.

Member - £500Non Member - £1000Weekday Tefillin service only - £180 (Bar Mitzvah)

Payment*

Credit Card

We accept Visa, MasterCard
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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